fluoxetine
8 interactions related to fluoxetine
fluoxetine + sam-e
SAM-e has independent antidepressant and serotonergic activity, and combining it with fluoxetine can additively raise serotonergic tone, increasing the risk of serotonin syndrome and hypomania. Fluoxetine's long half-life means this risk persists for weeks after the last dose.
fluoxetine + kava
Kava carries a documented risk of hepatotoxicity and produces CNS depression, and combining it with fluoxetine raises the risk of additive sedation and liver injury. Kava also inhibits CYP2D6 and CYP3A4, the enzymes that metabolize fluoxetine, which can elevate fluoxetine levels and side effects.
fluoxetine + tryptophan
Fluoxetine blocks serotonin reuptake while tryptophan supplies raw material for serotonin synthesis, and the combination can produce serotonin syndrome. Fluoxetine's very long half-life (active metabolite norfluoxetine persists for weeks) extends the window of risk well beyond the last dose.
fluoxetine + saffron
Saffron (Crocus sativus) has independent antidepressant activity, including serotonergic effects demonstrated in randomized controlled trials, and combining it with fluoxetine can theoretically add to serotonergic tone. Fluoxetine's long half-life extends the window of potential interaction for weeks after the last dose.
fluoxetine + st. john's wort
Fluoxetine is an SSRI with a very long half-life (its active metabolite norfluoxetine persists for weeks), and St. John's wort independently raises serotonin via reuptake inhibition. Combined use can precipitate serotonin syndrome and, because of fluoxetine's slow elimination, the risk window extends well beyond the day of last dose.
cannabis + ssris
Cannabis cannabinoids inhibit CYP2C19, CYP2C9, and CYP3A4, raising plasma levels of SSRIs such as sertraline, citalopram, and escitalopram. Cannabinoids also modulate serotonin signaling, and case reports describe serotonin syndrome precipitated by high-potency cannabis in patients on SSRIs.
fluoxetine + 5-htp
Fluoxetine is an SSRI that blocks serotonin reuptake, and 5-HTP is the direct precursor that the body converts into serotonin. Combining them can raise synaptic serotonin to levels associated with serotonin syndrome, and fluoxetine's long-lived active metabolite norfluoxetine extends this risk for weeks after the last dose.
alcohol + fluoxetine
Fluoxetine (Prozac) and alcohol both depress the central nervous system, increasing drowsiness, dizziness, and impaired judgment. Fluoxetine and its active metabolite norfluoxetine have unusually long half-lives (1 to 4 days and 4 to 16 days), so alcohol effects can be amplified even when the drink and dose are taken hours apart.